Purpose <p>Laparoscopic total extraperitoneal (TEP) inguinal hernia repair is a well-established technique. In Taiwan, the National Health Insurance (NHI) covers the fees of the procedure and conventional mesh (polypropylene mesh), whereas the anatomical polyester mesh (Parietex™) requires additional self-pay. This study aimed to compare the outcomes of the conventional mesh with fixation versus the polyester mesh (without fixation) in laparoscopic TEP repair.</p> Methods <p>We retrospectively reviewed the medical records of male patients who underwent laparoscopic TEP repair between 2017 and 2021. Patients could choose between the conventional mesh with fixation (conventional mesh group) or self-paid Parietex™ mesh without fixation (anatomical polyester mesh group). The outcomes included operation (OP) time, prolonged length of stay (LOS), and postoperative complications.</p> Results <p>A total of 74 patients with 123 hernias were included, of which 36 patients (67 hernias) underwent the anatomical mesh without fixation, while 38 patients (56 hernias) underwent the conventional mesh with fixation. The mean OP time was 102.6 ± 45.6 and 88.5 ± 42.0&#xa0;min in the conventional and the anatomical polyester mesh group. After adjusting for body mass index, diabetes mellitus, cardiovascular disease, and hernia type, no significant differences were observed between the two groups in OP time (<i>p</i> = 0.152) and the risk of acute pain (<i>p</i> = 0.337), chronic pain (<i>p</i> = 0.816), seroma (<i>p</i> = 0.941), hydrocele (<i>p</i> = 0.423), or hematoma (<i>p</i> = 0.347).</p> Conclusions <p>The conventional mesh demonstrates non-inferior outcomes compared to the anatomical polyester mesh. Given that the anatomical polyester mesh is not reimbursed by Taiwan’s National Health Insurance (NHI), the use of the conventional mesh with fixation in TEP inguinal hernia repair may be a more cost-effective option in Taiwan.</p>